Healthcare Provider Details

I. General information

NPI: 1104299643
Provider Name (Legal Business Name): CATHERINE ELIZABETH RICE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2015
Last Update Date: 11/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1551 SHOUP CT
DECATUR GA
30033-4607
US

IV. Provider business mailing address

1551 SHOUP CT
DECATUR GA
30033-4607
US

V. Phone/Fax

Practice location:
  • Phone: 404-727-8350
  • Fax: 404-727-3969
Mailing address:
  • Phone: 404-727-8350
  • Fax: 404-727-3969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License NumberPSY003549
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: